Provider Demographics
NPI:1831963636
Name:BRENNEMAN, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:BRENNEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 STATE ROUTE 119 W
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:OH
Mailing Address - Zip Code:45302-9642
Mailing Address - Country:US
Mailing Address - Phone:937-638-5173
Mailing Address - Fax:
Practice Address - Street 1:9320 STATE ROUTE 119 W
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:OH
Practice Address - Zip Code:45302-9642
Practice Address - Country:US
Practice Address - Phone:937-638-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker